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研究生:郭斐如
研究生(外文):KUO, FEI-JU
論文名稱:冠狀動脈繞道手術出院病患健康照護需求及其相關因素之探討
論文名稱(外文):The Health Care Needs and Related Factors in Discharged Patients with Coronary Artery Bypass Graft Surgery.
指導教授:王桂芸
指導教授(外文):WANG KWUA-YUN
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:138
中文關鍵詞:冠狀動脈繞道手術健康照護需求健康信念症狀困擾
外文關鍵詞:Coronary artery bypass grafthealth care needshealth beliefsymptom distress
相關次數:
  • 被引用被引用:8
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  • 下載下載:232
  • 收藏至我的研究室書目清單書目收藏:1
中文摘要
冠狀動脈繞道手術是治療因心臟冠狀動脈阻塞引起的缺血性心臟疾病常見的醫療處置。研究顯示冠狀動脈繞道手術病患於出院後常必須面臨許多問題,病患常在出院後的前數週,會因為身心症狀感到難以適應,護理人員若能了解病患出院後之健康照護需求,並適時的提供相關之照護,可確保病患於出院後能持續恢復健康,逐步回復正常的日常活動,故本研究主要目的是探討冠狀動脈繞道手術出院病患之健康照護需求及其影響因素。本研究是一描述相關性與縱貫性研究,以某醫學中心之心臟外科門診為研究場所,研究對象為接受冠狀動脈繞道手術出院三個月內的病患,至94年5月止以立意取樣的方式共收58位個案,以症狀困擾量表、健康信念評估量表、健康照護需求量表等結構性問卷進行資料之收集,資料分析採描述性統計分析、t檢定、單因子變異數分析、皮爾森積差相關、重覆測量變異數分析與複迴歸分析。研究結果歸納如下:
(1)冠狀動脈繞道手術出院病患之健康照護需求出現的狀況依序為生理照護需求、訊息需求及心理社會照護需求,最常出現的需求項目包括傷口疼痛的處理、瞭解心臟復健運動的方法、疲憊問題的處理。
(2)健康照護需求滿足狀況以生理照護需求、訊息需求較高,心理社會照護需求最低,最不滿足的需求包括接受病友的支持和經驗分享、恢復生活品質與情緒困擾的調適等。
(3)健康照護需求之相關因素包括性別、職業狀況、術後住院天數、手術方式、是否罹患其他慢性病與症狀困擾等變項。
(4)健康照護需求之進展變化方面,病患出院後第一至二週、出院一個月與術後三個月,均達到顯著差異,並呈現趨低的情形。
(5)整體健康照護需求之重要預測因子為術後住院天數、症狀困擾、性別等;訊息需求之重要預測因子為術後住院天數、症狀困擾、性別與職業狀態;生理照護需求之重要預測因子為症狀困擾、性別、手術方式;心理社會照護需求之重要預測因子為症狀困擾、性別與是否罹患其他慢性病。
本研究所獲之資料可作為護理人員在照護冠狀動脈繞道手術病患之參考之依據,以提升此類病患之護理品質。
關鍵詞:冠狀動脈繞道手術、健康照護需求、健康信念、症狀困擾
Abstract
The Coronary Artery Bypass Graft(CABG)is one of the current medical treatment for patients with ischemic heart disease. The discharged patients receiving CABG often have physical and psychosocial discomfort and make them hard to tolerate. Understanding the health care needs and providing the necessary cares for the patients are helpful for patients’ recovery. The purposes of this study are to explore the health care needs of patients and identify the influencial factors related to these needs. This study was the descriptive correlation research and longitudinal design. The subjects was the patients receiving CABG and discharged within three months. Fifty-five subjects were recruited by purposive sampling from one medical center in Taipei area, Taiwan.. The structured questionnaires of the Symptom Distress Inventory, Health Belief Inventory and CABG patients’ Health Care Needs Inventory were used for data collection. Data were analyzed by the descriptive statistics, t test, one-way ANOVA, Pearson correlation, Repeat measure ANOVA and Multiple regressions. The results were summarized as follows:
1. The frequent order of health care need was physical care needs, informational needs and psychosocial care needs. The most frequent items were“to care surgery wound’’,“to receive instructions about heart rehabiliation’’ and“to care fatigue symptom’’.
2.Psychosocial care needs was least satisfied. The most unmet items were“to receive support from supporting group’’,“to restore formerly quality of life’’ and“to cope with emotional distress’’.
3.The factors influencing health care needs were hospital stay after surgery,
gender, employment status, concurrent chronic disease, operational type and symptom distress .
4.There was significant difference in health care needs between discharged one to two weeks, discharged one month, and three months after surgery. The tendency of health care needs’ change was gradually lessened.
5.The stepwise multiple regress showed that the most important predictors for overall health care needs included length of hospital stay after surgery, symptom distress and gender; the most important predictors for informational needs included length of hospital stay after surgery, symptom distress, gender and employment status; the most important predictors for physical care needs included symptom distress , gender, and operational type; and the predictors for psychosocial care needs included symptom distress, gender and concurrent chronic disease.
The results of this study may be as reference for the nurses to care the patients receiving CABG. The optimal goal is to enhance quality care of these patients.
Key words: Coronary artery bypass graft, health care needs, health belief, symptom distress
第一章 緒論
第一節 研究背景及重要性 1
第二節 研究目的 3
第二章 文獻查証
第一節 冠狀動脈繞道手術之相關概念 4
第二節 健康照護需求之相關概念 8
第三節 冠狀動脈繞道手術出院病患之健康照護需求及其相關研究 12
第四節 冠狀動脈繞道手術出院病患健康照護需求影響因素之相關
研究 21
第三章 研究架構與假設
第一節 研究架構 29
第二節 研究假設 30
第三節 名詞界定 31
第四章 研究方法與過程
第一節 研究設計 33
第二節 研究對象及場所 33
第三節 研究工具 34
第四節 量表信效度檢定 38
第五節 研究過程 41
第六節 資料分析 42
第七節 倫理考量 43
第五章 研究結果
第一節 冠狀動脈繞道手術出院病患之人口學特性 44
第二節 冠狀動脈繞道手術出院病患之疾病特性 45
第三節 冠狀動脈繞道手術出院病患之健康信念 47
第四節 冠狀動脈繞道手術出院病患之症狀困擾 48
第五節 冠狀動脈繞道手術出院病患之健康照護需求 51
第六節 人口學、疾病特性、症狀困擾、健康信念與健康照護需求
之關係 55
第七節 冠狀動脈繞道手術出院病患健康照護需求重要預測因子 59
第六章 討論
第一節 冠狀動脈繞道手術出院病患之人口學特性與疾病特性 65
第二節 冠狀動脈繞道手術出院病患之健康信念與症狀困擾 66
第三節 冠狀動脈繞道手術出院病患之健康照護需求 68
第四節 人口學、疾病特性、症狀困擾、健康信念與健康照護需求
之關係 71
第五節 症狀困擾及健康照護需求之變化 74
第六節 健康照護需求之重要預測因子 76
第七章 結論與建議
第一節 結論 78
第二節 建議 80
第三節 研究限制 82
參考資料 84
附錄一 個案基本資料表 133
附錄二 健康照護需求量表 134
附錄三 症狀困擾量表 136
附錄四 健康信念量表 137
附錄五 專家效度名單 138
表格目錄
表一 健康照護量表的分類 93
表二 專家效度評分結果 95
表三 因素分析後之健康照護需求量表 96
表四 因素分析後之健康信念量表 97
表五 問卷信度之結果 98
表六 冠狀動脈繞道手術出院病患之人口學特性 99
表七 冠狀動脈繞道手術出院病患之疾病特性 100
表八 冠狀動脈繞道手術出院病患之健康信念 101
表九 人口學、疾病特性變項與健康信念之相關性分析 102
表十 人口學、疾病特性變項與健康信念之關係 103
表十一 冠狀動脈繞道手術病患出院一至二週之症狀困擾 104
表十二 冠狀動脈繞道手術病患出院一個月之症狀困擾 105
表十三 冠狀動脈繞道手術病患術後三個月之症狀困擾 106
表十四 冠狀動脈繞道手術病患症狀困擾之變化 107
表十五 人口學、疾病特性變項與症狀困擾之關係 108
表十六 人口學、疾病特性變項與症狀困擾之相關性分析 109
表十七 冠狀動脈繞道手術病患出院一至二週之健康照護需求 110
表十八 冠狀動脈繞道手術病患出院一個月之健康照護需求 111
表十九 冠狀動脈繞道手術病患術後三個月之健康照護需求 112
表二十 冠狀動脈繞道手術病患健康照護需求之變化 113
表二十一冠狀動脈繞道手術病患健康照護需求之滿足狀況 115
表二十二人口學變項與健康照護需求之關係 117
表二十三人口學變項與訊息需求之關係 118
表二十四人口學變項與生理照護需求之關係 119
表二十五人口學變項與心理社會照護需求之關係 120
表二十六疾病特性變項與健康照護需求之關係 121
表二十七疾病特性變項與訊息需求之關係 122
表二十八疾病特性變項與生理照護需求之關係 123
表二十九疾病特性變項與心理社會照護需求之關係 124
表三十 健康照護需求之相關性分析 125
表三十一健康照護需求與健康照護需求各次量表需求之相關性 126
表三十二整體健康照護之逐步複迴歸分析 127
表三十三訊息需求之逐步複迴歸分析 128
表三十四生理照護需求之逐步複迴歸分析 129
表三十五心理社會照護需求之複迴歸分析 130

圖目錄
圖一 Kalish人類需求階層理論 10
圖二 冠狀動脈繞道手術出院病患健康照護需求之概念架構 31
圖三 冠狀動脈繞道手術出院病患症狀困擾之變化 131
圖四 冠狀動脈繞道手術出院病患健康照護需求得分之變化 132
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